Cytoreductive Surgery and Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma

Cytoreductive Surgery and Intraperitoneal Chemotherapy

Abdoma ina  I exposure

The abdominal cavity opens through an incision of the midline from the Xiphoid to Pubis. The old abdominal incision is widely removed, including Umbilicus. The edges of the skin are insured by heavy sutures for the self-revenue. Traction at the edges of the abdominal incision raises the structures of the abdominal Wali to facilitate its precise dissection. 

The strong elevation of abdominal Wali helps to avoid damage to the intestinal loops that adhere to the anterior abdominal wall (Sugarbaker 2008; Lima Vázquez and Sugarbaker 2003). This is especially important in patients who have had previous surgery. The generous abdominal exposure is achieved by using a Thompson self-retention retractor (Thompson Surgical Instruments, Inc., Traverse City, MI).

Total Peritonectomy Pari ET I

As the peritoneal dissects away from the posterior rectus sheath, a single entry into the peritoneal cavity at the top of the incision (peritoneal window) allows the surgeon to evaluate the requirement of a complete parietal peritonectomy (Fig. 3.3). 

In general, the MPM nodules are felt in the parietal peritoneum. If so, complete dissection can be indicated to achieve full cytoreduction (by Lima Vázquez and Sugarbaker 2003b). If the PM does not involve the parietal peritoneum, except for the small defect in the peritoneum required for this peritoneal exploration, the rest of the peritoneum remains intact.

The self-retention retraction system is constantly advanced along the anterior abdominal Wali. This opts for broad traction at the point of dissection of the peritoneum of its underlying tissues. The dissection tool is the tip of the ball, and the evacuation of smoke is continually used (Sugarbaker 1994). It is more adherent directly than exceeding the transverse muscle. 

In some cases, dissection of aspects lower than superiors of the abdominal Wali facilitates cleaning in this area. The dissection is combined with the right and upper left sub-left peritonectomy and with the full pelvic peritonectomy in a lower way. 

As the dissection continues beyond the peritoneum that exceeds the paracolic groove (Tell line), the dissection becomes faster with the loose connections of the peritoneum in this anatomical site.

Left subphrenic peritonectomy

Peritonectomy procedures are greatly facilitated by the self-return retractor provided by the continuous exposure of all abdomen quadrants, including the pelvis. Epigastric fat and peritoneum on the edge of the abdominal incision are removed from the posterior rectus sheath. 

Strong traction is exercised in the tumor sample throughout the upper left quadrant to separate the tumor from the diaphragmatic muscle, the left adrenal gland, and the upper half of the perirenal fat. The splenic flexion of the colon is cut from the left abdominal gutter and moves medially dividing the peritoneum along the Telltt line. 

Dissection under the hemidiaphragm muscle is performed with electro surgery with a ball tip, as well as overwhelming dissection (Fig. 3.4). Numerous blood vessels should be visualized between the diaphragm muscle and its peritoneal and individually electro coagmented surface before its unnecessary transition or bleeding occurs as the cut blood vessels retract in the diaphragm muscle.

Major and possible splenectomy omentectomy

To release the average abdomen of a large volume of tumor, the largest omentectomy-splenectomy is performed. The major omentum rises and then separates from the cross colon using electrosurgery. 

This dissection is contained under the peritoneum that covers the transverse mesocolon to expose and avoid the lower edge of the pancreas. The branches of the gastroepiploic arcade to the greatest curvature of the stomach are linked in continuity and then divide. Because the peritonectomy of the upper left quadrant has been completed, the deep beneath structures.

Source

Harvey I. Pass, Nicholas Vogelzang, Michele Carbone - Malignant Mesothelioma_ Pathogenesis, Diagnosis, and Translational Therapies-Springer (2005)
Mary Hesdorffer, Gleneara E. Bates-Pappas - Caring for Patients with Mesothelioma_ Principles and Guidelines-Springer International Publishing (2019)
Bruce W S Robinson, A Philippe Chahinian - Mesothelioma (2002).

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